Evidence-Based Decision Making 4: Clinical Practice Guidelines.

Clinical practice guidelines (CPGs) are systematically developed statements to assist practitioners and patient to reach appropriate health-care decisions. The synthesis and translation of a large amount of evidence into practice recommendations should ultimately reduce the use of unnecessary or harmful interventions, help patients to achieve maximum benefit, and minimize risk, all at an acceptable cost.In the past, CPGs were developed based on expert opinion, and using consensus methodology either formally or informally. Over the last 30 years, the evolution of increasingly transparent and robust methodology has led to more "evidence-based" recommendations. Clinical practice guidelines should be developed within the principles of bias minimization, systematic evidence retrieval and review, and a focus on patient relevant outcomes. Multiple nationally based and international groups now have published specific guidance for the development, dissemination, and evaluation of CPG.This chapter describes the key principles of CPG development, including the importance of updating, disseminating, and evaluating the impact of CPG , and attempts to differentiate CPG intended for populations of patients from "evidence-based decision making" for individual patients, recognizing that the fundamental principles are the same.